Provider Demographics
NPI:1306689203
Name:RAHBAR, SHOHREH (DC)
Entity type:Individual
Prefix:
First Name:SHOHREH
Middle Name:
Last Name:RAHBAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S BEACH BLVD APT L1116
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-1187
Mailing Address - Country:US
Mailing Address - Phone:562-458-0042
Mailing Address - Fax:
Practice Address - Street 1:1501 S BEACH BLVD APT L1116
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-1187
Practice Address - Country:US
Practice Address - Phone:562-458-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor